HSSERE1A, Rev.

01
Incident Report Form GA: Shivpuri

Incident Title: Doing Stringing with wrong approach by using webbing sling at single point.

Category

 Fire & Explosion  Material Damage

 Gas Release  Near Miss
 Human Injury  Unsafe Act
 Road Accident  Unsafe Condition
 Security Incident  Complaint/Grievances
 Environmental Incident  Journey Violations
Impact
Nature of Injury Material Damage
 Fracture  Electric  Loss beyond premises

 Head Injury
Shock
 Above 10 Lacs
 Thermal Burn
 Cuts/Wounds  INR 5 to 10 Lacs
 Electric Burn
 Internal Injury  Upto INR 5 Lacs
 Intoxication
 No significant loss
Description
Date of Incident 03.07.2020 Time of Incident 17.45 PM
NH 26 (Current Mainline Welding location)
Incident location with
GPS Coordinates
 HSSERE1A, Rev. 01
Incident Report Form GA: Shivpuri

Course of events: While riggers are performing stringing beside of the road, using webbing sling
tied two pipes, in unbalance way (Not using directional controlling ropes, immediately stopped
them and briefed on right approach to weigh and stringed in right manner.
Note:- No personnel Injury.

Personal Injury
Details of Injured Person Injured Party
Name
Designation :
: NA
 THINK Employee  Visitor
Company :  Contractor Employee  Other
Injured body parts:
 Skull  Back  Arm
 Eye  Leg  Hand
 Teeth  Foot  Pelvis
 Skin  Thorax  Others
Lost working days: NA
Response
Immediate
Measures taken: Operation get stopped & Briefed on the causes of it.

Parties informed: Bhartiya Infra

Estimated Loss (INR)

Physical damage: NA
Product loss: NA
Environmental clean-up: NA
Other claims: NA
 HSSERE1A, Rev. 01
Incident Report Form GA: Shivpuri

Incident Causes

1. Can cause road accident due unbalancing of Weighed Pipe. (i.e. activity performed near road)
2. Riggers can get Injured due to un-tied pipe at both ends.

Corrective Action & Recommendation

SN Action Point Responsible Person Target Date
1. Use proper Lifting Hooks with Wire Rope Sling. Mr. Aman Singh 04.07.2020

2. While Lifting or Stringing is performed on Site, Supervision is Mr. Chandan Kumar 04.07.2020
Mandatory.
3. Resource allocation like appropriate tool & tackles as per activity Mr. Pappu Kumar 04.07.2020
specific should be available on site: Wire rope sling with Eye’s (Hooks)

Incident Closure
Date 03.07.2020 Time 17.57 PM
Document Control
Action Name Date Signature
Saurabh Choudhary 04.07.2020
Report preparation

Report Review

Report Approval